What are opioids, also known as opiates, and why are they commonly prescribed? When an over-the-counter pain medication such as aspirin, acetaminophen or ibuprofen isn’t strong enough, doctors often prescribe an opioid. They are controlled, highly addictive narcotic drugs that reduce the intensity of pain, according to the National Institute on Drug Abuse. Depending on the nature of the pain, a physician might recommend one of these drugs: Hydrocodone (Vicodin), Oxycodone (Percocet), Morphine (Kadian, Avinza)or Codeine. These drugs are regulated and can be expensive. Another popular, but illegal, opioid in common use is heroin.

Morphine is often used before and after surgical procedures to relieve severe pain. It is often used to comfort patients being treated for end-stage, terminal cancer. Hydrocodone products are most commonly prescribed for a variety of painful conditions, including dental, arthritic and injury-related pain. Codeine is commonly prescribed for mild pain. In addition to their pain-relieving properties, some of these drugs — codeine and diphenoxylate (Lomotil) for example — can be used to relieve coughs and severe diarrhea, according to the NIDA.

Heroin comes in different forms. It can be a white or brown powder or a black, sticky goo. It’s made from the seedpod of the Asian poppy plant. It can be mixed with water and injected with a needle. Heroin can also be smoked or snorted. All of these ways of taking heroin send it to the brain very quickly. Regular use of heroin can lead to tolerance, which results in users needing more and more drug to have the same effect. At higher doses over time, the body becomes dependent on heroin. Heroin is used by millions of addicts around the world who are unable to overcome their dependency knowing that if they stop, they will face the horror of withdrawal. Health problems from heroin use include miscarriages, heart infections and death from overdose. People who inject the drug also risk getting infectious diseases, including HIV/AIDS and hepatitis.

Efforts to increase opioid use and a campaign touting the alleged under treatment of pain continue to be significant factors in the escalation. Many arguments in favor of opioids are based solely on traditions, expert opinion, practical experience and uncontrolled anecdotal observations, according to the Pain Management Center of Paducah, Kentucky (PMCP). This evolved into the introduction of new pain management standards by the Joint Commission on the Accreditation of Healthcare Organizations. In 2000, there was an increased awareness of the right to pain relief, the introduction of consumer organizations supporting the use of opioids in large doses plus aggressive marketing by the pharmaceutical industry. PMCP contends these positions are based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe because they are prescribed by physicians.

The 2010 National Survey on Drug Use and Health found that an estimated 22.6 million, or 8.9 percent of Americans, aged 12 or older, were current illicit drug users. The escalating use of therapeutic opioids shows hydrocodone topping all prescriptions with 136.7 million prescriptions in 2011. Opioid analgesics are now responsible for more deaths than those resulting from both suicide and motor vehicle crashes. Sixty percent of deaths occur in patients who have been given prescriptions based on guidelines set by medical boards. Forty percent of deaths occur in individuals abusing the drugs obtained through multiple prescriptions and doctor shopping. The PMCP authors of “Opioid Epidemic in the United States” conclude that the obstacles that must be surmounted are inappropriate prescribing patterns which are largely based on a lack of knowledge, and inaccurate belief of under treatment of pain.